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Organizations in Africa and Elsewhere Les Organismes en Afrique et ailleursAuthor(s): Ronald M. WintrobSource: Canadian Journal of African Studies / Revue Canadienne des Études Africaines, Vol. 2,No. 1 (Spring, 1968), pp. 97-103Published by: Taylor & Francis, Ltd. on behalf of the Canadian Association of African StudiesStable URL: http://www.jstor.org/stable/484000 .

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NOTES

Organizations in Africa and elsewhere Les organismes en Afrique et ailleurs

Report on the 2nd PanAfrican Psychiatric Conference

The 2nd PanAfrican Psychiatric Conference was convened in Dakar, Senegal, from the 5th to the 9th of March, 1968, under the co-chairmanship of Professor Henri Collomb, Professor of Neuropsychiatry, University of Dakar, and Professor T.A. Lambo, Professor of Neurology, Neurosurgery, and Psychiatry, University of Ibadan, Nigeria. Among the 230 participants in the conference less than ten had been present at the first PanAfrican Psychiatric Conference which was held in Abeokuta, Nigeria, in 1961. The total number of participants at the second conference was far greater than that of the first, reflecting the rapid development of scientific interest in African psychiatry and the conco- mitant rapid increase of mental health facilities and psychiatric personnel working in Africa. Other differences between the two conferences were the exclusion of neurology from the programme of the present conference, and the extremely limited participation by British psychiatrists in the second Pan- African conference whereas the earlier conference had been largely dominated by the British school of neurology and psychiatry, prominently represented by Sir Aubrey Lewis and Lord Brain. The second PanAfrican Psychiatric Confe- rence, receiving as it did an important element of financial support from the French government through its technical assistance branch, was largely dominated by the French school of psychiatry. Senior French participants included Professor Castaigne, Professor of Neurology and Neurosurgery at the University of Paris, and Professor Roger Bastide, Professor of Social Psychiatry at the Sorbonne.

The increasing scientific interest in problems of African psychiatry is reflected by the wide distribution of participants from both African countries and other parts of the world, including Hong Kong, Israel, Uruguay, Western and Central Europe, Canada and the United States. By far the largest delegation of non-African participants came from France and the second largest group was Canadian. The Canadian group was represented by some fifteen psychiatrists

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LE JOURNAL CANADIEN DES ETUDES AFRICAINES

of whom thirteen were from Quebec. The American delegation was somewhat smaller than the Canadian. There were no British participants in the Confe- rence. A large number of African countries were represented. Among the African countries represented at the conference were Kenya, Ethiopia, Ghana, Malawi, Liberia, the Ivory Coast, the Niger Republic, the Malagasay Republic, Tanzania, Uganda and Zambia. The United Arab Republic, Tunisia, and the Sudan also sent representatives.!

Excluding Southern Africa there are at present three university departments of psychiatry in Sub-Sahara Africa. The largest of the three departments and the only one whose chairman and members are predominantly African is the Department of Neurology, Neurosurgery and Psychiatry at the University of Ibadan. A second department of psychiatry in the anglophone areas of Africa is located in East Africa at Makerere College in Uganda. This department was established in 1965 under the chairmanship of the British psychiatrist Allen-German. The third sub-Sahara university department of psychiatry is that of Professor Collomb at the University of Dakar, which is staffed by some ten psychiatrists and psychologists of whom the majority are French.

In the period since the first PanAfrican Psychiatric Conference in 1961 the body of literature on African psychiatry has greatly expanded, due in large part to the focal stimulation of the three university departments and most particularly the longer-established departments at Dakar and Ibadan. North of the Sahara, university departments of psychiatry have been in existence for some time in Algeria and the United Arab Republic, and more recently in Tunisia and the Sudan.2

Although there has been a great increase in the number of psychiatrists participating in the development of psychiatric facilities in Africa, it will be appreciated that the demand for facilities and services far outstrips the available numbers of personnel and in most of the countries listed there is usually only one or at most a few psychiatrists available. The overwhelming majority of psychiatrists in Africa south of the Sahara are Europeans and North Americans whose activities are sponsored by international agencies, foreign aid programs of developed countries, or by direct support from the host governments. Typical of the participation of Europeans in the development of psychiatric facilities in Africa is the work of the Dutch psychiatrist Giel and his sociologist colleague Van Liujk in Ethiopia. With the support of the government of the Netherlands

1. A South African scientist arrived in Dakar to participate in the conference, but in part as a result of a student demonstration against South African participation, the South African delegate was obliged to leave Senegal post haste.

2. It should be borne in mind that in African studies a sharp distinction is drawn between Sub-Sahara or Negro Africa and Africa north of the Sahara: Arab Africa. A considerable antipathy and suspiciousness has characterized the relations between Arab and Negro Africans, based on the repeated incursions of Arab slavers into Sub-Saharan Africa over the course of many centuries.

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THE CANADIAN JOURNAL OF AFRICAN STUDIES

Giel and Van Liujk have, since 1966, done pioneering work in establishing the prevalence of psychiatric disorders in the hospitalized and non-hospitalized population, the mental health implications of the high frequency of marriage breakdown and parental loss in childhood and the psychological effects of urbanization. Similarly the government of Israel has contributed in an important way to the development of psychiatric facilities in Malawi and in Liberia. The development of psychiatric facilities in the Republic of Liberia has resulted from the combined efforts of the Liberian government, the Liberian Red Cross Society, the International Committee Against Mental Illness (New York), McGill University, and the Menninger Foundation. In East Africa mental health facilities have been developed with British participation as illustrated by the work of Haworth in Zambia, Allen-German and Orey in Uganda, and Swift in Tanzania. The Government of France continues to play an important part in the development of mental health facilities and psychiatric education in the Francophone areas of Sub-Saharan Africa, particularly in Senegal and the Ivory Coast. However, just as the number of psychiatrists per country can usually be numbered on the fingers of one hand, so the number of psychiatric wards in general hospitals or of psychiatric hospitals per se in each country can similarly be numbered on the fingers of one hand.

The role of native healers and faith healers in the care of the mentally ill varies from country to country. In some countries, such as Nigeria, native healers have been intergrated into the psychiatric treatment team, whereas in Uganda they have been banned from practice by law. In Ghana, where the role of native healers and faith healers has been studied by Kirson Weinberg and by M.J. Field, the Government officially disapproves of their activities, but they are tolerated. In virtually all sub-Saharan countries the treatment of mental disorders in rural areas is almost exclusively in the hands of native healers. Understandably therefore the role and treatment techniques of native healers and faith healers were important topics for discussion at the second PanAfrican Psychiatric Conference.

The Conference was well organized by the staff of the Depart- ment of Neuropsychiatry of the University of Dakar with the back-up support of the French technical assistance mission to Senegal. Plenary sessions were organized during each morning and in the afternoons five concurrent workshops were held. Simultaneous translation was provided. The plenary sessions were devoted to clinical psychiatry, treatment modalities, social psychiatry, research and training. The subjects of the five workshops were as follows: socio-cultural factors in schizophrenia, problems of migration and acculturation, problems of inter-disciplinary research, the socio-cultural context of therapy in Africa, and cultural factors related to psychopathology. In addition to the plenary and working sessions several outstanding films relevant

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to African psychiatry were presented. Of these films two deserve special mention. One was produced by the eminent French ethnographer and film-maker Jean Rouch of the Mus6e de l'Homme in Paris. Titled Le Maitre Fou, the film records the group possession ceremony of the Haouka sect in pre-independence Ghana. A second outstanding film was the inaugural showing of the healing ceremony of a depressed, middle-aged woman, conducted by a Senegalese mara- bout who has worked in close collaboration with Professor Collomb and his colleagues in Dakar. This film was titled N'doep.

Turning to the scientific presentations, they can be broadly divided into papers dealing with clinical psychiatric problems, descriptions of the therapeutic techniques of native healers and faith healers, and general discussions of the relationship of social and cultural factors to mental illness in Africa. Papers were largely descriptive and impressionistic with a relative lack of methodolo- gical vigour and testing of hypotheses. Among the papers relating to traditional treatment techniques in Africa, Dr. J.P. Lehmann, who has worked for two years in the Ivory Coast, gave a well illustrated discussion of the treatment techniques of two native healers whom he has studied. In his presentation he stressed that religious healers reject beliefs in genii and fetish cults as causes of mental illness and utilize two essential components in treatment: prayer and holy water. In contrast, the native healer divines the nature of the illness, the type of witchcraft employed, the particular genii responsible for the patient's illness, and prescribes the appropriate rituals and sacrifice for their elimination.

A closely related series of papers dealt with possession states. Dr. R. Wintrob outlined the folk beliefs and psychotic elaborations concerning possession by a spirit called "Mammy Water." These beliefs are widely shared by tribes in Liberia and other parts of West Africa and are prominently represented in the delusional systems of some twenty percent of hospitalized psychotic patients in Liberia. Professor Bastide of Paris, in a paper on Problems of Possession among Africans and Afro-Americans, struck a recurring chord in the Conference by discussing the relationship of possession states to psychotherapy. Bastide contrasted the ethnologist's interest in possession states with that of the psychiatrist. Ethnologists, he contended, are primarily interested in the normative social function of possession and the role of possession states in averting future misfortune. In some societies possession may serve as an avenue of search for political power. Or again possession in some societies may be used by women as a lever of revenge and a search for power against the dominant social and religious position of men. In this context the Zar cult of Ethiopia and the Gelede cult of the Yoruba in Nigeria were considered. Bastide also stressed that possession states may be seen by ethnologists as a normal religious outlet both through exorcism and in the invocation of divine spirits. In contrast to this approach of the ethnologist, Bastide contended that the psychiatrist was

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primarily concerned with the psychopathology of possession states and the psychopathology, latent or manifest, in those who become possessed.

Another group of papers outlined the traditional belief system in relation to mental illness. An important contribution to this area of investigation was the paper by Wittkower and Weidman devoted to the integration of anthro- pological and psychoanalytic theory of magic, witchcraft, and sorcery in relation to mental health and mental disorder. J.L.M. Dawson, describing the effects of social change on attitudinal conflict and emotional adjustment in Sierra Leone, stressed the integrity of fundamental beliefs in witchcraft and spirit possession among acculturating Sierra Leoneans and especially among Sierra Leone students. The problems of discontinuities in enculturation were discussed by Abiola of Nigeria in relation to public school children, by Amous- sou who outlined types of psychotic disorders among high school students in Senegal, and Duverge who described problems of adaptation and social mal- adjustment of university students. And coming full cycle again on this series of papers, Sangmuah, a Ghanaian psychiatrist trained at the University of Toronto, described traditional healing practices in northern Ghana.

Descriptive clinical studies of psychopathology in Africa comprised another major group of papers. Typical of these papers was one by Okasha of the United Arab Republic describing the nosological characteristics of approximately 2,000 out-patient psychiatric consultations at the University of Cairo in 1966. Profes- sor Lambo summarized a decade of research into the characteristics of schi- zophrenic disorders among Nigerians. Another highly significant longitudinal study was reported by Martino. In this study a year-by-year statistical analysis of all hospitalized patients at the Dakar-Fann Psychiatric Service from 1958 to 1967 was reported on. It was found that throughout the ten year period, the diagnosis of schizophrenia remained stable at about fifteen percent of hospitalized patients. The analysis showed further that the diagnosis of acute confusional states decreased from about thirty percent in 1958 to about five percent in 1967, while the diagnosis of bouffees delirantes (acute paranoid reactions) increased over the same period from less than five percent to more than twenty-five percent. In his analysis of these findings, Martino suggests that as clinical experience increased and a sounder appreciation of social and cultural factors developed, so a greater appreciation of the importance of transitional paranoid thinking became apparent.

Another important area of clinical reports concerned itself with the clinical features of psychological decompensation of African students and workers living in France. Dr. F. Raveau gave a preliminary report of extensive investigation of 410 African students and apprentices pursuing courses in France since 1960. Raveau stressed the interdisciplinary nature of this study, incorpo- rating psychological and social work approaches in addition to clinical psychiatric

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investigation. It was found that about five percent of the 410 students became psychotic and were hospitalized, about ten percent gave evidence of neurotic difficulties requiring treatment, and about fifteen percent required some consultation or social work assistance without continued psychiatric intervention. It was found that the highest rate of psychiatric consultation occurred after the students had been in France for about six months.3 Raveau stressed that trainees who had been expected to perform at a very high level of efficiency on their return to Africa did not achieve the high standard of performance that was expected of them. Contrariwise, those trainees who had experienced break- downs while in France tended to perform at a higher level of efficiency than had been expected when they returned to their countries or origin.

Dr. T. Asuni of Nigeria presented his findings of an investigation of vagrant psychotics in the area of Abeokuta, Nigeria. Between 1965 and 1967, thirty-five such vagrant psychotics were studied. Two social agencies participated in the study, which included the investigation of attitudes toward vagrant psychotics on the part of the population of Abeokuta. Vagrant psychotics comprised about one per 3,000 population of the town, where they were found mainly in non-residential market areas. In-patient investigation of twenty-five subjects confirmed the diagnosis of simple schizophrenia in twenty-three cases. Asuni stressed that while disturbed communication was characteristic of these patients, they did not withdraw from social interaction and displayed a need to communicate in a devious way. It was found that the population at large tolerated the presence of these patients and attributed their condition to witchcraft or "God's will."

Dr. J. Murphy of Harvard University reported on the relation of culture change to the mental health of 138 men in fifteen Yoruba villages studied by the Cornell-Aro team headed by Professors Leighton and Lambo. It was found that younger men who have less social status than older men who are venerated in the community show much more symptomatology of emotional disturbance than do older men. Men who have been converted to Christianity show more symptomatology than those who have retained animist beliefs. Those men who had several years of schooling and who were literate but not school graduates showed more symptomatology than the men who had no formal education. This was especially true among Christians. Those literate Christians who found "modern" work in contrast to traditional farming did not reveal a higher incidence of emotional symptomatology than the normal population. These preliminary findings seem to point to the conclusion that literacy without adequate occupational training contributed in a negative way to the social and emotional adjustment of Yoruba men. On the other hand, literacy combined

3. This finding of (presumably) more manifest psychopathology occurring at about six months in the new cultural milieu, bears comparison with findings of psychological dysadaptation among Peace Corps Volunteers.

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with vocational training that would equip a Yoruba man for participation in an urban industrial society contributes to the potential for mental health and social integration. Dr. Murphy describes it in these terms: "A little bit of education may shake a person out of the old world, but it does not enable him to move into the new."

Perhaps this is an appropriate note on which to end this brief summary of a selection of papers presented at the 2nd PanAfrican Psychiatric Conference. In conclusion, it must be stated that a primary purpose of a meeting of this type is to bring together workers in the various disciplines concerned with the development of psychiatric facilities and psychiatric research in Africa. Among the results of the interchange of ideas that takes place within the context of the conference milieu are the defining of problems for investigation and the improvement of channels of communication. With specific reference to the value of improved communication among colleagues, one tangible result of the Conference was the organization of the African Psychiatric Society. Discussions were undertaken with a view to organizing integrated post-graduate training in Africa for African psychiatrists and social scientists. To quote from the inaugural remarks of the Minister of Health of the Republic of Senegal: "The time has come when we must stop relying on borrowed talent."

2 April 1968. Ronald M. Wintrob McGill University

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